Ronald Dixon, M.D., M.A, is the Associate Medical Director at Massachusetts General Hospital (MGH) Beacon Hill Internal Medicine Associates, and the Director of the Virtual Practice Pilot at Massachusetts General Hospital.
Dr. Dixon completed his undergraduate work at McGill University, graduate work in clinical neuropsychology at University of Buffalo, and medical training at Dartmouth Medical School. He completed residency training at Massachusetts General Hospital. He recently completed an Administrative Fellowship with the Massachusetts General Physicians Organization (MGPO), and currently serves as a Project Director for the MGPO.
Dr. Dixon’s interests are in alternative methods of health care delivery, specifically relating to general internal medicine. Dr. Dixon sits on a number of committees designed to make care delivery more efficient and effective for patients and physicians. He is actively pursuing clinical practice based research in this domain, supported by the MGH and the Center for the Integration of Medicine and Innovative Technology (CIMIT). His current projects include ‘Virtual Visits in General Medicine,’ ‘Primary Care Kiosks,’ ‘Low Acuity Clinics,’ and ‘Remote Physiological Monitoring in Patients at Risk for Chronic Disease.’ Dr. Dixon’s clinical interests are disease prevention, behavior management, chronic disease management, and care of patients with malignancies.
Question: How can we reduce costs and improve quality in healthcare?
Ron Dixon: So there are certain systems that are in the United States right now that seemed to be able to provide better value-based care. These systems that are commonly mentioned are Kaiser or Mayo Clinic or Geisinger, and what they do is that they have the ability to provide care across the continuum. So if you see someone within the system, you’re likely referred to somebody else within the system, and that information that is obtained from the first person you saw is seen by that second person, so you reduce the cost of repetition.
Additionally, those systems tend to control their administrative cost a lot tighter, and they also tend to follow certain things like formulary restrictions, and they have decision-support for their physicians in their electronic medical records that they use, and they all have the basically 100% electronic medical record utilization.
Question: What are some advantages and disadvantages of electronic medical records?
Ron Dixon: Electronic medical records are important because they allow for information sharing.
The problem with electronic medical records is that if there are a hundred different vendors and therefore a hundred different records and information cannot be shared across so-called systems. So, if you as provider X has a certain system and me as provider Y has a different system, those system don’t share information in the current state. As a result the goal of the record, in terms of making information portable and transferable is lost.
They’re very effective within the system so the tests aren’t repeated. You can see tests that were done the previous day or the previous month. They’re very good for trending tests and trending information. But the real promise of the electronic medical record is not obtained until you have a way to link different records with different information systems.
So if you would think of the electronic medical record as the car. Right now the administration is buying cars, but we need to build roads so that the cars can travel, and all that information that is obtained at a practice in Denver can be seen at a practice in Boston if the consultation has occurred in Boston. There, the promise of the records starts to come to fruition.
Additionally the record can also provide a way for the patient to have some input and access to information about their care. If the record not only becomes the EMR, the electronic medical record, but becomes a window to the personal health record, I believe that they should be one and the same, that the physician should be able to see a part of patient’s record and that the patient should have access to the same information in a view that he or she can understand. That would allow the promise of the record to really be realized, because once you start giving patients access to their information, you start empowering patients, you start empowering self management and you start really developing a shared strategy of care between the patient and the care provider.
Question: What aspects of healthcare should the US government focus on?
Ron Dixon: I think that the government should also think about investing in things that enabled patients to take better care of themselves. So, again the medical record is not enough. We need something that patients can see and we need them to access to their information, whether it’s through readily available technology like a cell phone or a laptop or a pass-key that they can go to a public library and get their information. Yes, there is a question of safety, but that has to be managed appropriately.
I think those are the types of things that the government should be spending their money on from a technological perspective. Very simple solutions that people can understand and embrace, as opposed to again whiz-bang things that people typically are not going to use.
It’s not the technology that makes the difference it’s the implementation scheme and the people behind the technology that matter.
Recorded on: May 28, 2009